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Chest pain and shock: Is there a right ventricular OMI on this ECG? And should he undergo trancutaneous pacing?

Dr. Smith's ECG Blog

A 50-something man presented in shock with severe chest pain. The patient was in clinical shock with a lactate of 8. We recorded an ECG in which V1-V3 were put in the position of V4R-V6R, and V4-6 were placed in V7-9 to (academically) confirm posterior OMI. RVMI explains part of the shock.

Shock 97
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Sniffing out Sepsis - Vibes vs Scoring Systems?

Taming the SRU

National campaigns to improve sepsis care, namely the Centers for Medicare and Medicaid Services’ introduction of “Severe Sepsis and Septic Shock Early Management Bundle”, have faced many challenges in physician and provider adherence. Sepsis as a disease process has been difficult to both clearly define and quickly recognize.

Sepsis 89
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Is a Cuff Enough?

Taming the SRU

3) Methods This study was a retrospective observational study at a single academic tertiary care facility in their medical intensive care unit (MICU). Surviving sepsis campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. 53286 measurement pairs were recorded with a median of 13 measurements per patient.

Sepsis 94
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The Safety and Efficacy of Push Dose Vasopressors in Critically Ill Adults

RebelEM

They can be associated with side effects such as reflex bradycardia, decreased stroke volume in phenylephrine, tachycardia and hypertension associated with epinephrine. Nontraumatic hypotension and shock in the emergency department and the prehospital setting, prevalence, etiology, and mortality: a systematic review. 2006;130(4):941–6.

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SGEM#267: Afib of the Night – Chemical vs. Electrical First Cardioversion

The Skeptics' Guide to EM

SGEM#88 : Shock Through the Heart (Ottawa Aggressive Atrial Fibrillation Protocol) * SGEM#133 : Just Beat It (Atrial Fibrillation) with Diltiazem or Metoprolol? Background: Atrial fibrillation is the most commonly encountered significant dysrhythmia in the emergency department (1). We have covered this topic a number of times on the SGEM.

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Links to My Recent Writing and Speaking

Stop and Think

It is actually simple: you use an online calculator to get your 10-year risk of a heart attack or stroke. The first ORBITA trial shocked the cardiology world when it failed to find a placebo-resistant effect of stenting substantial coronary lesions. Academic Publishing I am now up to a modest 76 peer-reviewed co-authored papers.

Stroke 44
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Atrial fibrillation? Multifocal Atrial Tachycardia? Don't look at computer read until AFTER you interpret!

Dr. Smith's ECG Blog

speci fi city of the General Electric (GE) algorithm for AF, but they excluded cases with ventricular paced rhythm (VPR), in which the underlying atrial rhythm was frequently AF;we did not exclude VPR, as accurate identi fi cation of AF in VPR is important for determination of stroke risk [ 22 ]. Poon et al. sensitivity and 98.9%

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